1. Vol. 33 No. 02 07th - 13th January 2006
Losing or Gaining?
In the long pathway of the human history,
being a socialized animal, along with the
growth of the global population, their needs
also have grown. Driven by these needs a par-allel
instrumental development can be ob-served.
At the same time, the natural environ-ment
is also apt to change. Although these
mechanical changes facilitated the human ac-tivities,
they equally gave rise to health haz-ards.
The biological and mechanical causes for
health problems have been deeply explored
enough. However, the impact of sociological
factors on the human health has not been ex-plored
equally. Whatsoever the reason for un-der
exploration, if the health of a nation is to
be improved this vacuum has to be filled with
anthropological studies. Researchers need to
improve their capabilities to describe the com-plex
issue of biological, mechanical and socio-logical
relevance of health problems. If this is
addressed, the gaining in health sector devel-opment
in a country would be comprehensive
and complete.
Other than their basic requirements, most of
the individual’s needs are determined by the
peer pressure of that community. The peer
group is generally managed by the local poli-tics,
which is the representative of the global
politics under the authorized blanket of
“globalization.” This influence may affect the
community in various intensities according to
their social, cultural, economical as well as
spiritual beliefs and practices. Within these
circumstances some individuals are unable to
withstand the peer pressure. Hence their tar-gets
are automatically set beyond their basic
needs, resulting in their demands being unable
to be met with the available limited resources
in a particular community. This situation com-pels
them to use their strengths or capabilities
to gain more resources. These resources may
be money - the symbol of purchasing power,
materials or person-hours.
Driven by economic hardships in one end and
by social pressure form the other end, people
are looking for new avenues to earn more
money. In achieving these goals some social,
cultural and spiritual values are ignored or
dropped from the priority list. Mother leaving
the family for foreign employment is such a
move, where the other responsibilities of a
mother within the family unit are surpassed by
the need for income generation. Female em-ployment
in a foreign job is considered as one
of the main solutions for economic hardships,
by the family, by the community and finally by
the government. Remittance from foreign em-ployment
constitutes the largest net foreign
exchange earned by the nation. In the year
2003, private remittances to Sri Lanka
amounted to Rupees 136 billion and Middle
East migrants contributed 56.9% of this
amount. Although this mother migration has
continued for 25 years, there is a query yet,
whether this remedy is appropriate for the
disease called poverty of the family or the
country.
It is estimated that around 600,000 females are
(Continued on page 2)
Contents Page
1. Leading Article - Losing or Gaining?
2. Surveillance of vaccine preventable diseases & AFP (31st December 2005 - 06th January 2006)
3. Summary of diseases under special surveillance (31st December 2005 - 06th January 2006)
4. Summary of Selected notifiable diseases reported (31st December 2005 - 06th January 2006)
1
3
3
4

2. Page 2
(Continued from page 1)
currently working abroad as housemaids. This has forced an
estimated one million children to live without their mothers.
Mother leaving the family makes many sudden changes in
the family structure and also in the traditional responsibilities
of each member of the family. Child would experience that
the mother image is suddenly replaced by his or her grand
mother, father, an elder sister or any other relative. In turn,
an elder female child may have to bear the responsibilities of
a mother looking into the needs of younger siblings and other
members of the family. This may perhaps, force them to
change their living from the familiar environment to a new
strange location. Whether this new caregiver is capable to
look after the child’s nutrition, education, security, health and
emotional needs are never considered beforehand. Whether
the child can emotionally tolerate the mother’s absence is also
never addressed. Whether these negative impacts will be
compensated by the financial gain is worth exploring.
The children below five years of age left behind by their par-ents
are the most affected segment of the society, due to
negative impact of their health and emotional development.
Moderate and severe malnutrition is common due to the sud-den
termination of breast feeding. Some children are so at-tached
emotionally to their care giver it takes some time to
get used to re-join with their own mother on her return.
Older children of expatriate mothers become insolent, disobe-dient,
and defiant. In instances where older children were not
supervised adequately, results poor school performance or
even school drop-out. These problems are never resolved
completely even after the mother’s return.
A recent study done among the 13-15 year children revealed
that, physical, educational and emotional neglect are signifi-cantly
higher among children of Middle East migrant moth-ers
than among mother available children. Most of the chil-dren
are cared by either grand mother or father in the
mother’s absence. Children’s main concerns were the loss of
maternal love and affection and the absence of suitable person
to discuss their grievances with. It appears that the surrogate
cannot take over the mother’s role to the satisfaction of the
child. The linear association of these causes with their out-comes
are difficult to explicit. But these various causative
factors are reflected by behaviour of children. This study esti-mated
the prevalence of behavioural problems - conduct and
emotional disorders as 18.7% for mother available children
and 42.2% among children of expatriate mothers. These be-havioural
problems could be presented with various psycho-logical
as well as somatic complaints. Hence, awareness of
this special risk group of children is definitely beneficial for
the clinical practitioners. The same study revealed poor
school performance is manifested as increased school drop
out, absenteeism and low marks obtained by migrant moth-ers’
children when compared with others. This negative im-pact
on children should be communicated with the people
who plan for foreign employment, since a better education for
their children is a prime objective of many of those mothers
seeking foreign employment.
On the other hand physical punishment at the school is more
frequently received by children of mother abroad than the
others. This may be due to poor school performance or their
behavioural problems. Whatsoever the cause they have been
physically abused than the mother-available children. The
teachers should therefore be aware of these children and find
alternative ways to make them disciplined.
The main expectation of foreign employment is to earn more
money than what they can in Sri Lanka. A sociological study
on the economy of the returnees from Middle East revealed
that 9% of migrants return empty handed. Another 62% of
the returned migrants possessed less than Rs. 50,000. This
suggests that the majority of returnee migrants do not earn a
considerable amount of money as they wished. Only 3.4 % of
the migrant in the sample could bring an amount of money
over Rs. 50,000. Thus expectation of a greener pasture has
not been fulfilled for most migrant females. On the other
hand the financial management of the family is also not satis-factory;
most of the members in the mother-abroad families
being addicted to alcohol and smoking than others.
All the evidence reveal the stark reality of the disaster caused
by the female migration of those families in general and their
children especially undergoing. The children are more prone
to abuse and are at a high risk of behavioural and psychologi-cal
problems. One of the main expectations – better education
also has not materialized. The economical gain for the family
is not noteworthy in most instances. The disruption of family
relationships is often hard to mend. The evidence on this
negative impact on the family due to migrant mother is well
enough to act upon. But the pull and push factors for mothers
seeking foreign employment are still operating in the society.
The controlling of this health related sociological phenome-non
is beyond the limit of single discipline. If a real change is
desired, not only the medical professionals, but also politi-cians,
policy makers, economists, and sociologists should act
in close rank. It is high time for all the stakeholders to inter-vene
in this problem and take control measures at the level of
decision-making.
This article is compiled by Dr. Anura Jayasinghe and is
based on his study “Physical Abuse and Neglect among
13 - 15 Years Old Children of Migrant Mothers in Kandy
District.”
WER Sri Lanka - Vol. 33 No. 02 07th - 13th January 2006

3. Page 3
Table 1: Vaccine-preventable diseases & AFP 31st December 2005 - 06th January 2006(1st Week)
Disease
No. of Cases by Province
Number
of cases
during
current
week in
2006
Number
of cases
during
same
week in
2005
Total
number
of cases
to date in
2006
Total
number
of cases
to date in
2005
Difference
between the
number of
cases to date
between 2006
& 2005
W C S NE NW NC U Sab
Acute Flaccid
Paralysis
00 00 00 00 00 00 00 00 00 02 00 02 -100.0%
Diphtheria 00 00 00 00 00 00 00 00 00 00 00 00 00.0
Measles 00 00 00 00 00 00 00 00 00 01 00 01 -100.0%
Tetanus 00 01
KD=1
00 00 01
KR=1
00 00 00 02 00 02 00 -
Whooping
Cough
00 00 00 00 00 00 00 00 00 02 00 00 -100.0%
Tuberculosis 99 97 31 05 06 00 00 78 316 223 316 223 +41.7%
Table 2: Diseases under Special Surveillance 31st December 2005 - 06th January 2006(1st Week)
Disease
No. of Cases by Province
Number
of cases
during
current
week in
2006
Number
of cases
during
same
week in
2005
Total
number
of cases
to date in
2006
Total
number
of cases
to date in
2005
Difference
between the
number of
cases to date
between 2006
& 2005
W C S NE NW NC U Sab
DF/DHF* 72 13 26 02 18 02 03 08 144 46 144 46 +213.0%
Encephalitis 00 00 01
MT=1
00 00 01
KR=1
00 00 02 01 02 01 +100.0%
Human Rabies 00 00 00 01
JF=1
02
PU=2
00 00 00 03 00 03 00 -
*DF / DHF refers to Dengue Fever / Dengue Haemorrhagic Fever; Details by districts are given in Table 3.; NA= Not Available
Source : Weekly Return of Communicable Diseases :Diphtheria, Measles, Tetanus, Whooping Cough, Human Rabies, Dengue Haemorrhagic
Fever, Japanese Encephalitis
Special Surveillance : Acute Flaccid Paralysis
National Control Program for Tuberculosis and Chest Diseases : Tuberculosis
Key to Tables 1 and 2 :
Provinces :W=Western, C=Central, S=Southern, NE=North & East, NC=North Central, NW=North Western, U=Uva, Sab=Sabaragamuwa.
DPDHS Divisions :CB=Colombo, GM=Gampaha, KL=Kalutara, KD=Kandy, ML=Matale, NE=Nuwara Eliya, GL=Galle, HB=Hambantota, MT=Matara, JF=Jaffna,
KN=Kilinochchi, MN=Mannar, VA=Vavuniya, MU=Mullaitivu, BT=Batticaloa, AM=Ampara, TR=Trincomalee, KM=Kalmunai, KR=Kurunegala,
PU=Puttlam, AP=Anuradhapura, PO=Polonnaruwa, BD=Badulla, MO=Moneragala, RP=Ratnapura, KG=Kegalle.
Rubella vaccination at SMI in 2006
With the new EPI schedule introduced in 2001, all children who had completed three years of age are given Measles-Rubella (MR) vaccine. The very
first cohort of children who had MR vaccine in 2001 will be eight years of age in 2006. Therefore they are eligible for Rubella vaccine in the School
Medical Inspection (SMI) in 2006.
The principal aim of rubella vaccination is to prevent congenital rubella syndrome caused by acquiring the infection during the early period of the
pregnancy. This is achieved by attaining the immunity by child bearing women and by stopping the circulation of rubella virus in the community. Since
rubella vaccine results in immunity for a prolonged period of time perhaps, a life long immunity, usefulness of a second vaccine has to be decided. It
has not yet been decided to immunize these children with a second dose of Rubella at eight years of age since a second dose of Rubella will be more
appropriate if given at an age more closer to the child bearing age period. However, this matter is open for further academic and scientific delibera-tion
and a policy decision will be taken very soon at the earliest.
Therefore it has been decided not to administer a second dose of Rubella vaccine during SMI for eight year old children who had had their MR vac-cine
at three years of age. If a child possesses a written document such as the Child Health Development Record (CHDR) or other immunization re-cord
which records the administration of MR vaccine at three years of age they need not to be given Rubella vaccine at the SMI. However, during
SMI as usual, Rubella vaccine should be given to those eight years old children who were not given MR vaccine at three years of age
or those who do not have a written proof of MR immunization. A letter to this effect has already been dispatched to all Provincial
Directors and Deputy Provincial Directors of Health Services.
This will be in practice until a policy decision is taken on this matter.
WER Sri Lanka - Vol. 33 No. 02 07th - 13th January 2006

4. WER Sri Lanka - Vol. 33 No. 02 07th - 13th January 2006
Table 3: Selected notifiable diseases reported by Medical Officers of Health
31st December 2005 - 06th January 2006 (1st Week)
Dengue
Fever / DHF*
Dysentery Encephalitis Enteric
PRINTING OF THIS PUBLICATION IS FUNDED BY THE UNITED NATIONS CHILDREN’S FUND (UNICEF).
DPDHS
Division
Comments and contributions for publication in the WER Sri Lanka are welcome. However, the editor reserves the right to accept or reject items
for publication. All correspondence should be mailed to The Editor, WER Sri Lanka, Epidemiological Unit, P.O. Box 1567, Colombo or sent by E-mail
chepid@sltnet.lk
ON STATE SERVICE
Dr. M. R. N. ABEYSINGHE
EPIDEMIOLOGIST
EPIDEMIOLOGICAL UNIT
231, DE SARAM PLACE
COLOMBO 10
Fever
Food
Poisoning
Leptos-pirosis
Viral Hepatitis Returns
Received
Timely**
A B A B A B A B A B A B A B A B %
Colombo 39 39 03 03 00 00 03 03 00 00 01 01 00 00 00 00 46
Gampaha 21 21 00 00 00 00 01 01 08 08 01 01 00 00 04 04 57
Kalutara 12 12 02 02 00 00 01 01 05 05 02 02 00 00 00 00 60
Kandy 12 12 07 07 00 00 00 00 00 00 03 03 01 01 01 01 59
Matale 00 00 03 03 00 00 00 00 00 00 00 00 00 00 00 00 67
Nuwara Eliya 01 01 01 01 00 00 02 02 00 00 00 00 01 01 00 00 29
Galle 04 04 00 00 00 00 00 00 00 00 01 01 00 00 00 00 56
Hambantota 01 01 02 02 00 00 01 01 00 00 03 03 01 01 02 02 80
Matara 21 21 01 01 01 01 00 00 00 00 02 02 06 06 00 00 87
Jaffna 01 01 09 09 00 00 02 02 00 00 00 00 19 19 02 02 63
Kilinochchi 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 75
Mannar 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00
Vavuniya 01 01 06 06 00 00 03 03 00 00 00 00 00 00 00 00 75
Mullaitivu 00 00 00 00 00 00 02 02 00 00 00 00 00 00 00 00 50
Batticaloa 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 20
Ampara 00 00 05 05 00 00 00 00 00 00 00 00 00 00 00 00 57
Trincomalee 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 11
Kurunegala 14 14 11 11 01 01 05 05 00 00 00 00 00 00 01 01 76
Puttalam 04 04 10 10 00 00 00 00 00 00 00 00 00 00 08 08 89
Anuradhapura 02 02 03 03 00 00 04 04 00 00 01 01 01 01 01 01 58
Polonnaruwa 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 71
Badulla 02 02 10 10 00 00 00 00 00 00 00 00 00 00 00 00 60
Monaragala 01 01 05 05 00 00 06 06 00 00 02 02 01 01 00 00 90
Ratnapura 07 07 10 10 00 00 00 00 00 00 00 00 00 00 00 00 53
Kegalle 01 01 04 04 00 00 00 00 00 00 03 03 00 00 00 00 55
Kalmunai 00 00 06 06 00 00 00 00 00 00 00 00 00 00 09 09 42
SRI LANKA 144 144 98 98 02 02 30 30 13 13 19 19 30 30 28 28 59
Source : Weekly Returns of Communicable Diseases ( WRCD )
*Dengue Fever / DHF refers to Dengue Fever / Dengue Haemorrhagic Fever
**Timely refers to returns received on or before 14th January 2006 :Total number of reporting units = 279.
A = Cases reported during the current week; B = Cumulative cases for the year;
Typhus
Fever